Martineau Tim, McPake Barbara, Theobald Sally, Raven Joanna, Ensor Tim, Fustukian Suzanne, Ssengooba Freddie, Chirwa Yotamu, Vong Sreytouch, Wurie Haja, Hooton Nick, Witter Sophie
Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK.
Nossal Institute for Global Health, University of Melbourne, Melbourne, Australia.
BMJ Glob Health. 2017 Jul 28;2(2):e000327. doi: 10.1136/bmjgh-2017-000327. eCollection 2017.
Conflict and fragility are increasing in many areas of the world. This context has been referred to as the 'new normal' and affects a billion people. Fragile and conflict-affected states have the worst health indicators and the weakest health systems. This presents a major challenge to achieving universal health coverage. The evidence base for strengthening health systems in these contexts is very weak and hampered by limited research capacity, challenges relating to insecurity and apparent low prioritisation of this area of research by funders. This article reports on findings from a multicountry consortium examining health systems rebuilding post conflict/crisis in Sierra Leone, Zimbabwe, northern Uganda and Cambodia. Across the ReBUILD consortium's interdisciplinary research programme, three cross-cutting themes have emerged through our analytic process: communities, human resources for health and institutions. Understanding the impact of conflict/crisis on the intersecting inequalities faced by households and communities is essential for developing responsive health policies. Health workers demonstrate resilience in conflict/crisis, yet need to be supported post conflict/crisis with appropriate policies related to deployment and incentives that ensure a fair balance across sectors and geographical distribution. Postconflict/crisis contexts are characterised by an influx of multiple players and efforts to support coordination and build strong responsive national and local institutions are critical. The ReBUILD evidence base is starting to fill important knowledge gaps, but further research is needed to support policy makers and practitioners to develop sustainable health systems, without which disadvantaged communities in postconflict and postcrisis contexts will be left behind in efforts to promote universal health coverage.
世界许多地区的冲突和脆弱性正在加剧。这种情况被称为“新常态”，影响着十亿人口。脆弱和受冲突影响的国家健康指标最差，卫生系统最薄弱。这对实现全民健康覆盖构成了重大挑战。在这些情况下加强卫生系统的证据基础非常薄弱，受到研究能力有限、不安全因素带来的挑战以及资助者对该研究领域明显的低优先级等因素的阻碍。本文报告了一个多国财团的研究结果，该财团考察了塞拉利昂、津巴布韦、乌干达北部和柬埔寨冲突/危机后卫生系统的重建情况。在重建财团的跨学科研究项目中，通过我们的分析过程出现了三个贯穿各领域的主题：社区、卫生人力资源和机构。了解冲突/危机对家庭和社区面临的交叉不平等现象的影响，对于制定适应性强的卫生政策至关重要。卫生工作者在冲突/危机中展现出韧性，但冲突/危机后需要通过与部署和激励措施相关的适当政策得到支持，以确保各部门和地理分布之间的公平平衡。冲突/危机后的背景特点是众多行为体涌入，支持协调并建立强有力的适应性强的国家和地方机构的努力至关重要。重建财团的证据基础开始填补重要的知识空白，但仍需要进一步研究，以支持政策制定者和从业者发展可持续的卫生系统，否则冲突后和危机后的弱势社区在促进全民健康覆盖的努力中将被抛在后面。
